The evolution of clinical significance

During the evolution of the concept of clinical significance, there has been a continuing dialog about and refinement of the construct. In this issue Sheldrick, Kendall, and Heimberg apply Kendall, Marrs-Garcia, and Sheldrick's method of equivalency testing and normative comparisons to treatments for conduct disorders. This method has important advantages over traditional meta-analytic approaches. However, analyzing results at the level of group means rather than the individual level loses significant information and can be misleading. Problems in reporting practices and inadequate attention to measurement issues continue to make efforts to assess the clinical importance of studies difficult. We renew a call for the assessment of clinical significance at the individual level of analysis, suggesting it is necessary to guide to selection of empirical supported treatments and in advancing theoretically driven programs of psychotherapy outcome research.